Page 48 - Preventing pertussis in early infancy - Visser

Chapter 3
increasing responsibilities that individual citizens have for healthcare decisions in other healthcare domains.
Opponents of voluntary vaccination might object that vaccination not only serves a personal goal (such as the health of individual patients in healthcare contexts), but also serves a collective goal (herd immunity). They therefore see no reason to try to ascribe the same role to members of the public in a public health situation as they have in the relationship between doctor and patient in a healthcare context. Blume and Goldenberg, however, remark that citizens do not always see or appreciate the difference between public health and healthcare and consequently deal with them in similar ways. It is because of this practical habit to relate to public health and healthcare in similar ways, that Blume and Goldenberg think vaccination should be voluntary.
Furthermore, similar to our own observations in our case study, Blume describes the bias respondents perceive in public health information. He notes that information provided by healthcare professionals is not satisfying to parents deciding on vaccination of their children as they realise it is ‘not designed to inform but to induce conformity.’ They consider it like ‘propaganda’ (Blume 2006). He considers this an obstacle to voluntary vaccination. This finding is also explained in public health ethics. Onora O’Neill analyses that public health government in voluntary vaccination programmes has a ‘hybrid role’: on the one hand it serves a public goal, striving to protect the public, and on the other hand it serves individual needs when it fosters individual decision making about participation (O'Neill 2003). Serving a public as well as a private good at the same time is, however, not an easy match. The ‘double’ or ‘hybrid’ role of public health government in voluntary vaccination is frequently said to lead to a moral conflict. According to public health ethicists Angus Dawson and Marcel Verweij, for example, it raises two obligations for public health government which cannot easily be combined: to propose and argue for the acceptance of vaccination programmes that can protect the health of the public, and to provide neutral information about it that enables people to make their own choice about whether to accept vaccination or not (Verweij et al. 2004). It is therefore unsurprising that the information provided about a programme is not considered neutral, if it is offered by the same organisation that proposes the programme.
Conclusion
In concluding this article, we argue that voluntary vaccination continues to be the better alternative in contexts where people (a) show broad support for voluntary vaccination, (b) do considerable effort to collect sufficient information to make an informed and deliberate choice, and (c) indicate mandatory vaccination leads to adverse effects on trust and uptake. A damaged relationship with the population could be detrimental to the success of vaccination programmes, as it depends on the people’s continued acceptance.
Given this conclusion, however, we also recognise that voluntary vaccination raises problems. Many authors have shown that people do not always make a choice based on information. This was also the case in our case study. Our respondents reported that they
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